Initiated in November 1999, the Maternal and Neonatal Health (MNH/Nepal) Program worked to support the Government of Nepal's safe motherhood (SM) programme to improve pregnancy outcomes for mothers and their newborns in the country. The MNH Program closed on September 30 2004. The U.S. Agency for International Development (USAID)'s follow-up project for maternal and newborn health, ACCESS, started on October 1 2004. MNH Partners in Nepal included JHPIEGO (a Johns Hopkins affiliate), the Johns Hopkins University Center for Communication Programs (JHU/CCP), and the Centre for Development and Population Activities (CEDPA). Specific objectives of the MNH/Nepal programme included:

Improved policy environment and coordination for safe motherhood;

Increased quality of safe motherhood services; and

Increased access to and demand for safe motherhood services.

Communication Strategies:

The SUMATA Initiative was a central component of the MNH/Nepal programme, with its emphasis on participation of key stakeholders. In November 2000, SM partners attended "Speaking with One Voice", a consensus-building workshop that brought together representatives of local, district, and national groups working in SM. A series of smaller workshops were organised to develop a SM advocacy strategy, a SM Information, Education and Communication (IEC) strategy, and SM messages. These activities were designed to enable programme planners to work together to promote birth preparedness and complication readiness by increasing knowledge and by modifying individual, community, and societal behaviours to reduce fatal delays.

Specifically, in Phase 1, which targeted areas where Emergency Obstetric Care (EmOC) services were not easily accessible, the messages for change focused on gender, women's status, household-level preparedness, and the husband's responsibility. In Phase 2 districts, where EmOC services were available and accessible, messages promoted EmOC services and care-seeking behaviours along with the Phase 1 messages.

Based on the objectives of the IEC Strategy for Safe Motherhood, MNH Program partner JHU/CCP worked with an advertising agency to develop a Nepali-language-based framework for the campaign, whose slogan was "Pregnancy and Childbirth are Special - Make Them Safe". SUMATA encouraged husbands and mothers-in-law, in particular, to care for the pregnant woman; to share love and affection, health information, and her workload; and to prepare for childbirth and potential complications. (In Nepali, Care, Share and Prepare is SUMATA, an acronym which also is a word in itself and loosely means Auspicious Mother in Sanskrit).

The SUMATA messages were woven into a multimedia initiative, which included radio spots and dramas, print materials, community-based street theatre performances, and a television drama. Two national radio spots were aired on Radio Nepal; seven six-minute SUMATA radio dramas were broadcast. These radio dramas were woven into 15-minute radio magazine programmes by the Nepal Safer Motherhood Program and were aired through the Surkhet Regional Radio Station in Nepali as well as in the Tharu language. Similar radio programmes were aired through Lumbini FM and Pokhara FM in Nepali as well as in local languages. Also, street theatre troupes performed over 100 dramas in various districts. Both the radio dramas and street dramas used the same basic scripts, thus reinforcing the same information. A variety of print materials were developed, including posters, lampshades, danglers, and prayer flags featuring the SUMATA images and messages.

MNH Program partner JHU/CCP completed a design workshop to develop a video drama that promoted caring husbands. The script was written by one of Nepal's dramatic scriptwriters and then produced by a Nepali production company. The video was shown on Nepali television, as well as in non-governmental organisation (NGO) locales and the popular cinema halls.

Development Issues:

Women, Children, Health, Gender.

Key Points:

In Nepal, maternal death is the largest cause of death for women of reproductive age. The 1996 Nepal Family Health Survey (NFHS) estimates that 539 women die for every 100,000 babies born.

Pre- and post-programme door-to-door surveys were conducted with currently pregnant women, their adult family members, community-based and government health workers, and selected members of the community.

In June 2002, street dramas were performed in the Baglung and Lalitpur districts of Nepal. An estimated 20,000 people saw the drama in the two districts, where a total of 32 performances were staged. Eighty percent of a sample of 235 audience members said they felt that by watching a drama played live in their own community, they became more emotionally involved in the issues and "learned a lot". Young students said they learned more from the drama than they could from their teachers, who were reluctant to discuss such topics.

Editor's Note: In May 2005, the MNH programme discontinued its activities in Nepal.

Partner Text:

JHPIEGO, JHU/CCP, CEDPA, PATH, Government of Nepal, international NGOs. Co-funded by USAID and UNFPA.

Source:

Email from Sereen Thaddeus to The Communication Initiative on January 13 2003; and MNH/Nepal website (no longer in operation; visit the ACCESS site for additional details); and Harvard Family Research Project's The Evaluation Exchange, Volume VIII, No. 3, Winter 2002 (Issue Topic: Public Communication Campaigns and Evaluation).

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